Substitute For

SENATE BILL NO. 668

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 17801, 17820, 17822, 17824, and 17825 (MCL 333.17801, 333.17820, 333.17822, 333.17824, and 333.17825), section 17801 as amended and section 17825 as added by 2009 PA 55, sections 17820 and 17822 as amended by 2016 PA 499, and section 17824 as amended by 2014 PA 260, and by adding section 17825a.

the people of the state of michigan enact:

Sec. 17801. (1) As used in this part:

(a) "Health care professional" means an individual who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state.

(b) (a) "Physical therapist" means an individual licensed under this article to engage in the practice of physical therapy.

(c) (b) "Physical therapist assistant" means an individual with a health profession subfield license under this part who assists a physical therapist in physical therapy intervention.

(d) (c) "Practice as physical therapist assistant" means the practice of physical therapy performed by a physical therapist assistant under the supervision of a physical therapist. licensed under this part.

(e) (d) "Practice Except as otherwise provided in subdivision (f), "practice of physical therapy" means the evaluation of, education of, consultation with, or treatment of evaluating, educating, consulting with, or treating an individual by the employment of employing effective properties of physical measures and the use of using therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting, to prevent, correct, or alleviating alleviate a physical or mental disability. Physical therapy includes examining, evaluating, and testing an individual with a mechanical, physiological, or developmental impairment, a functional limitation, or a disability or other health and movement-related condition to determine a cause of the physical therapy problem to be treated and a prognosis and plan for intervention; treatment planning; , the performance of tests and measurements; , the interpretation of referrals; , the initiation of referrals; , instruction; , consultative services; , and the supervision of personnel. Physical As used in this subdivision, "physical measures" include massage, mobilization, heat, cold, air, light, water, electricity, and sound.

(f) Practice of physical therapy does not include the identification of underlying medical problems or etiologies, establishment of medical diagnoses, or the prescribing of treatment.any of the following:

(i) The practice of medicine.

(ii) The practice of osteopathic medicine and surgery.

(iii) The practice of podiatric medicine and podiatric surgery.

(iv) Medical diagnosis or the diagnosis of a health condition, if the diagnosis falls outside the scope of practice of physical therapy.

(2) In addition to the definitions in this part, article 1 contains general definitions and principles of construction applicable to all articles in this code and part 161 contains definitions applicable to this part.

Sec. 17820. (1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons individuals authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.", and any similar words, titles, or letters that indicate that an individual is licensed under this part.

Sec. 17822. This part does not prohibit a hospital, as a condition of employment or the granting of staff privileges, from requiring that a physical therapist perform activities within his or her the physical therapist's scope of practice in the hospital if that treatment is prescribed by an individual who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state.a health care professional.

Sec. 17824. (1) A If a physical therapist who is treating a patient upon on the prescription of receipt of a referral from a health care professional, as described in section 17820 the physical therapist shall do all of the following, as applicable:

(a) Refer the patient back to the health care professional who issued the prescription made the referral for treatment if the physical therapist has reasonable cause to believe that symptoms or conditions are present that require services beyond the scope of practice of physical therapy.

(b) Consult with the health care professional who issued the prescription made the referral for treatment if the patient does not show reasonable response to treatment in a time period consistent with the generally accepted standards of for the practice as determined by the board.of physical therapy.

(2) A If a physical therapist who is treating a patient without a prescription referral from a health care professional, under the conditions authorized in section 17820 the physical therapist shall do all of the following, as applicable:

(a) Refer the patient to an appropriate a health care professional that the physical therapist considers appropriate for treatment if the physical therapist has reasonable cause to believe that symptoms or conditions are present that require services beyond the scope of practice of physical therapy.

(b) Consult with an appropriate health care professional 1 of the following if the patient does not show reasonable response to treatment within 60 days after initiating treatment or in a time period consistent with the generally accepted standards of for the practice as determined by the board.of physical therapy, whichever occurs first:

(i) If the patient identifies a health care professional as the patient's primary health care professional, the patient's primary health care professional.

(ii) If the patient does not identify a health care professional as the patient's primary health care professional, a health care professional who the physical therapist considers appropriate.

(c) If the patient identifies a health care professional as the patient's primary health care professional, within 15 days after initiating treatment inform the patient's primary health care professional of the initial evaluation and plan of care for physical therapy services for the patient.

(3) A physical therapist who is treating a patient shall consult with the health care professional who referred the patient for treatment, who the patient identifies as the patient's primary health care professional, or, if the patient does not identify a primary health care professional, who the physical therapist considers appropriate, as soon as possible but not later than 5 days after identifying any of the following:

(a) A measurable decline in the patient's condition that requires a significant change to the patient's plan of care.

(b) An exacerbation or progression of the patient's symptoms despite adherence to the patient's plan of care.

(c) A significant complication that was not present when the initial evaluation occurred and the plan of care was initially drafted for the patient.

Sec. 17825. This part does not require new or additional third party third-party reimbursement or mandated worker's compensation benefits for physical therapy services and does not preclude a third party third-party payer from requiring a member or enrollee to fulfill benefit requirements for physical therapy services, including, but not limited to, any of the following when services are rendered by an individual licensed or otherwise authorized under this part:

(a) A medical differential diagnosis to demonstrate medical necessity.

(b) A prescription. ,

(c) A referral. , or

(d) Preapproval. preapproval when services are rendered by an individual licensed or otherwise authorized under this part.

Sec. 17825a. A physical therapist who is treating a patient without a referral from a health care professional shall inform the patient of the patient's potential financial liability for receiving physical therapy services without the referral.

Enacting section 1. This amendatory act takes effect 180 days after the date it is enacted into law.